In recent years many fully invasive surgical and operative medical procedures have been adapted to utilize videoendoscopic techniques to achieve minimally invasive procedures. Rather than requiring a relatively large incision to gain access to internal anatomical structures, videoendoscopic techniques require a plurality of much smaller incisions. Generally, one incision is made for a videoendoscopic camera, and two or more incisions are made to introduce surgical instruments. The diameters of the surgical instruments and the probe for the videoendoscopic camera are made as small as practical, to minimize the size of the incisions that are required. The endoscope is used to enable the surgeon to view, in real-time, the surgical field and the manipulation of the endoscopic instruments within that field.
The majority of the videoendoscopic cameras in use today employ an optical fiber to transmit an image of the internal surgical field to a video camera that is disposed externally. Exemplary videoendoscopic cameras are described in U.S. Pat. No. 6,527,704 (Chang et al.). As indicated in FIGS. 1A and 1B of the Chang et al. patent, such systems tend to include a plurality of external components that are mounted together in a rack that can be moved from one operating theater or room to another, as required. While such systems work well in a surgical theater, their size, weight, limited mobility, and cost make such systems ill-suited for use in a training environment, where highly portable and lower cost devices are very desirable.
As technology improves so as to enable a substantial reduction in the size of video cameras, it has been suggested to employ small internal video cameras that have been inserted within the body of a patient, instead of using an optical fiber to transmit the image from the surgical field to an external video camera. Systems of this type are described in U.S. Pat. No. 5,754,313 (Pelchy et al.), U.S. Pat. No. 6,139,489 (Wampler et al.), and U.S. Pat. No. 6,211,904 (Adair et al.). However, at the present time, small video cameras that can be disposed at an internal surgical field have not supplanted more conventional videoendoscopic systems that employ fiber optics to transmit internal images to an external camera, either for actual surgical use or in a training context, such as simulations or skill development exercises.
The need for endoscopic surgical training systems is significant. Hand eye coordination skills useful in conventional surgery do not translate well into endoscopic surgery. In conventional surgery, a surgeon is able to look directly at the treatment site, and is generally able to see his hands and the instruments in the surgical field in three dimensions. In videoendoscopic surgery, the surgeon is not able to feel the tissue and/or organs associated with an operative site first hand, because the surgeon remotely manipulates the tissue and/or organs using elongate surgical tools from outside the surgical field. Further, the surgeon observes a two-dimensional image of the surgical field. The ability to work from a two-dimensional image of the surgical field, while remotely manipulating instruments, requires a significant amount of training. It is critical that surgeons be taught and thereafter practice videoendoscopic skills that will help them to identify structures and carefully control endoscopic instruments, to ensure that surgical procedures are accurately performed, and to avoid unnecessary damage to surrounding tissue. Even basic surgical skills, such as suturing and knot tying, become challenging when performed endoscopically. In a videoendoscopic environment, such basic surgical tasks require great skill and precision, which can only be achieved through training and practice.
For surgeons or students who require basic training, skills unique to videoendoscopic surgery need to be learned. Two-dimensional recognition skills must be learned, as well as the manipulation of objects using elongate surgical instruments. Another skill that needs to be learned is the ability to use such elongate surgical instruments to manipulate objects when the view of the workspace is very restricted.
A wide variety of different elongate surgical instruments have been developed, and continue to be developed, for use in endoscopic surgery. Even surgeons who have mastered two-dimensional recognition skills and the manipulation of objects using elongate surgical instruments welcome the opportunity to familiarize themselves with new instruments in a training context, prior to using such instruments during an actual procedure.
Surgeons and other medical personnel can be trained in endoscopic surgical techniques using animal specimens or human cadavers. However, such training methods are very expensive, since animals and cadavers are in limited supply and cannot be used repeatedly. Also, animal specimens and human cadavers are not readily portable.
Many endoscopic techniques, such as instrument manipulation, can be successfully learned using simple box trainers. Such trainers generally include a housing in which a simulated anatomical structure is placed. Students can manipulate instruments passing through openings in the housing to gain confidence in such skills as suturing and knot tying. Some box trainers have openings through which the student can look to directly observe the simulated anatomical structure. While such a trainer is effective for gaining skills related to remote manipulation of endoscopic instruments, since the trainee looks directly at the simulated anatomical structure, two-dimensional recognition skills cannot be learned and practiced. Thus, some box trainers employ mirrors that reflect an image of the practice site, so that the trainee can also gain the necessary two-dimensional recognition skills. U.S. Pat. No. 5,722,836 (Younker) discloses one such box trainer.
Box trainers are relatively inexpensive and very portable, and are therefore desirable teaching tools. It must be recognized, however, that box trainers, including those that employ mirrors to develop two-dimensional recognition skills, do not provide a very realistic simulation of a true videoendoscopic procedure. During an actual endoscopic procedure, the surgeon will be observing an image displayed on a monitor. While a conventional endoscopic camera could be introduced into a box trainer to provide a video image of the simulated anatomical structure at a practice site, conventional endoscopic cameras are not very portable, and are very expensive. Such a training system, while being more realistic in simulating an actual surgical environment than a box trainer with a mirror, no longer offers the low cost and portability of a box trainer alone. It would thus be desirable to provide a low cost and highly portable trainer that is capable of providing a video image of a practice volume and of remotely manipulated endoscopic instruments being utilized within the practice volume.